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Low Dose Dexamethasone Suppression Test Protocol PDF

This document provides information and instructions for performing a low dose dexamethasone suppression test (LDDS) to diagnose hyperadrenocorticism (Cushing's disease) in dogs. The LDDS involves collecting blood samples before and 4 and 8 hours after administering dexamethasone. Cortisol levels are interpreted to determine if they are suppressed as would be expected in normal dogs or remain elevated, indicating hyperadrenocorticism. The LDDS is highly sensitive but specificity is reduced in dogs with other illnesses. Precautions are discussed if steroids have recently been administered.

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Vicentiu Predescu
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347 views

Low Dose Dexamethasone Suppression Test Protocol PDF

This document provides information and instructions for performing a low dose dexamethasone suppression test (LDDS) to diagnose hyperadrenocorticism (Cushing's disease) in dogs. The LDDS involves collecting blood samples before and 4 and 8 hours after administering dexamethasone. Cortisol levels are interpreted to determine if they are suppressed as would be expected in normal dogs or remain elevated, indicating hyperadrenocorticism. The LDDS is highly sensitive but specificity is reduced in dogs with other illnesses. Precautions are discussed if steroids have recently been administered.

Uploaded by

Vicentiu Predescu
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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IDEXX

Laboratories Ltd
Grange House, Sandbeck Way
Wetherby
West Yorkshire LS22 7DN
tel: UK: +44 (0)20 378 87508
Eire:+353(0) 156 21211
fax: +44 (0)1937 544001
e-mail: [email protected].
DEXAMETHASONE SUPPRESSION TEST (LOW DOSE)
(LOW DOSE)

Canine Low Dose Dexamethasone Suppression Test


Indications
Diagnostic test for the differentiation of normal dogs from those with
hyperadrenocorticism (Cushing’s disease).
Note
a) In most situations low dose dexamethasone suppression testing (LDDS) is
regarded as the test of choice for diagnosis of hyperadrenocorticism in the dog.
Reported sensitivities for LDDS for diagnosis of hyperadrenocorticism range from
90-95%, suggesting LDDS to be a more sensitive test than ACTH stimulation
testing. However, 5-10% of cases will be negative when first evaluated and will
require retesting after a few months. Specificity of LDDS is poor (51%) in dogs
with non adrenal disease and concurrent illness (particularly diabetes mellitus
and renal failure.) Positive test results should always be interpreted in light of
history and clinical signs

b) Determination of whether animals with diabetes mellitus have concurrent


hyperadrenocorticism may be difficult. In such cases both the ACTH
stimulation test as well as the low dose dexamethasone suppression test have
been reported to produce false positive results. In most instances a combination
of both tests in addition to an ultrasonographic examination of the adrenal
glands are necessary for complete diagnostic evaluation. Please contact the
laboratory to discuss the approach to such cases

c) LDDS testing cannot be used for diagnosis of hypoadrenocorticism (Addison’s


disease). ACTH stimulation testing is the only test that can be used to make this
diagnosis.

d) LDDS testing cannot be used for monitoring patients receiving trilostane


(Vetoryl). Only ACTH stimulation testing, 4-hour post trilostane basal cortisol
concentrations, or pre- and 4-hour post trilostane basal cortisol concentrations
can be used to monitor patients receiving treatment with trilostane.

e) Where there has been administration of oral, injectable, or topical steroids,


LDDS testing should be delayed for at least 2-4 weeks after the withdrawal
of therapy to allow normalisation of the pituitary-adrenal axis. Longer withdrawal
times may be needed for long acting steroids, even when used topically

Page 1 of 2

UK-LCS-PRO-12 Rev.5.1 Dexamethasone Suppression Test (Low Dose)


f) Prior administration of delmadinone (Tardak) and progestagens such as
proligestone (Delvosteron) may also significantly affect LDDS test results for
variable periods of time. Please contact the laboratory for further advice on
testing these cases.

Protocol
Volumes of dexamethasone use for intravenous injection to perform LDDS testing are
small. In some cases, especially i n small dogs, it can be helpful to dilute the
dexamethasone in saline or sterile water for injection before administration.
1) Collect 1-2 mL blood in plain/gel tube. Serum should be spun and separated and
labelled with the name of the patient and the time of the sample.
2) Inject dexamethasone (0.01 mg/kg) intravenously.
3) Collect second blood sample 4 hours post injection of dexamethasone.
4) Collect third blood sample 8 hours post injection of dexamethasone.
5) All samples should be spun and separated and labelled with the name of the patient
and the time of the sample.
6) Submit separated serum samples and request form to the laboratory.
Please include a history, including drug history and select the appropriate
test code (DEXL) to allow interpretation of the result.

Patterns of results on LDDS Testing

Basal cortisol Cortisol 4 hours Cortisol 8 hours Interpretation


post post
dexamethasone dexamethasone
Any Any <40 nmol/L Negative for
hyperadrenocortiscm
Normal <50% of basal or >40 nmol/L Pituitary dependent
<40 nmol/L hyper- adrenocorticism
(false positives with
stress or concurrent
disease)
Normal >50% basal or >40 nmol/L but Pituitary or adrenal
>40 nmol/L <50% of basal dependent
hyperadrenocorticism

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UK-LCS-PRO-12 Rev.5.1 Dexamethasone Suppression Test (Low Dose)

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